When Going Home From the Hospital Is Done Well

\r\nHe has published in several medical journals, including recent research on use disparities in telehealth visits & effective community outreach interventions to encourage COVID vaccination. His weekly MedPage Today column, \u201cBuilding the Patient-Centered Medical Home,\u201d focuses on improving patient care.<\/p>“,”affiliation”:””,”credential”:”MD”,”url_identifier”:”fp4223″,”avatar_url”:”https:\/\/assets.medpagetoday.net\/media\/images\/author\/Pelzman_330px.png”,”avatar_alt_text”:”Fred Pelzman”,”twitter”:””,”links”:null,”has_author_page”:1,”byline”:”Contributing Writer, MedPage Today”,”full_name”:”Fred Pelzman”,”title”:”Contributing Writer, MedPage Today, “,”url”:”https:\/\/www.medpagetoday.com\/people\/fp4223\/fred-pelzman”,”bluesky”:””}]”/>

Being in the hospital is challenging.

Taking care of patients in the hospital is challenging (bless the hospitalist physicians). Going home from the hospital — returning home to outpatient world where so many of our patients spend the vast majority of their lives — also can be challenging. But we can probably do better.

How many of us practicing in this outpatient world have received discharge summaries from our patients when they come see us after they were hospitalized at some outside facility, burdened down with reams of paper, often containing a lot of data but no clear pattern, no clear story, and in the end sometimes no idea what happened, what the truth really was.

Our patients tell us, “I was feeling bad; the ambulance took me to a hospital. They did a lot of tests; they gave me some medication; I had some sort of procedure and surgery. They changed my medicines, and they told me to see you so that you could tell me what to do next. So what do I do next?”

You know the line from the Bible that says it’s better to give than to receive? Maybe we can get to a place where it’s better to give and to receive.

When it comes to dealing with our hospitalized patients, there are very few things that we in outpatient medicine like more than communicating with the inpatient physicians who carry the burden of managing our patients during a critical time in their lives. That includes letting us know that our patient has been admitted, keeping us updated on the course of their illness, seeking our counsel and feedback on what’s going on and how they are responding to treatment, and then clearly communicating about the discharge plan and who is responsible for what. These are the things that in totality can make for a successful transition from the inpatient world back to the outpatient world.

We recognize that our hospitalist colleagues are as busy, burned out, and as frazzled as we are, and may not have the time to do all of this background work when they have so many boxes to click, so many notes to write, so much care to coordinate among so many patients, along with the teaching of medical students, residents, and fellows.

To take time to touch base with each outpatient physician about the entirety of each patient’s hospital course is probably asking too much. But perhaps as we do more and more ambient listening in the inpatient environment along with more realistic collection and synthesis of what’s really happening during the hospital admission, and as we create better documents from all of this data and information, then summarizing it and getting it ready for turning it into a really decent outpatient transition plan could become a reality.

Today, when a patient is heading home and the hospitalist who has been caring for them reaches out to me, I love it when they suggest what they expect of me and what they’re hoping I can help them and our patient accomplish. That way I know what specialty care they need, what additional imaging or treatments are planned, what goals have been set, and what we need to do to keep the patient from bouncing back again to the hospital.

Maybe it’s time we let smarter systems loose to digest all of the data that is collected during hospitalization, and craft a better story about what happened and what needs to happen next. Then everyone could be tasked with what should happen, what medicine should be continued, which ones should be stopped, what follow-up imaging or testing is necessary and in what time frame, the order with which patients need to see subspecialists and primary care doctors, as well as clearly written out instructions for patients and the outpatient teams taking care of them.

As it stands, we often rifle through all of those sheets of paper they bring to us for their hospital discharge appointments, sometimes finding a little buried nugget of information that helps us know what happened and what the final diagnosis was. We’ve also gotten really good at figuring out what all of the stuff in there means. But there’s so much noise, so much data, such a regurgitation of morning labs, endless lengthy imaging reports, and often undecipherable progress notes, that there is rarely complete clarity about what really occurred and what the followup plan should be.

This chaotic healthcare system has overwhelmed us all: patients, their families, inpatient physicians, and their outpatient counterparts. Maybe with the assistance of artificial intelligence, we can corral all this information and do a better job of getting our patients home, making those first few days, weeks, months, and even subsequent years safer, and keep them from falling back to that state that landed them in the hospital in the first place.

So let’s learn to give as good as we get.

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